Community structure of benthic invertebrates in the Allipén River basin, North Patagonia, Araucania region (38º S, Chile) / Estrutura da comunidade de invertebrados bentônicos na bacia do rio Allipén, Patagônia Norte, Região da Araucanía (38º S, Chile)

One of the biological indicators most used to determine the health of a fluvial ecosystem are the benthic macroinvertebrates. The presence of recurrent species in a wide gradient of latitudes, dominates the biogeographic pattern of the benthic macroinvertebrates in Chilean fresh waters, nevertheless the knowledge on the communitarian ecology of these in the Chilean rivers continues to be scarce. Null models became a powerful statistical tool for describing the ecological mechanisms that drive the structure of an ecological community and the underlying patterns of diversity. The objective of this study was to determine the community structure of benthic invertebrates in the Allipén River by describing their composition, richness and abundance of species through richness models and null models based on presence/absence. The results reveal a high family richness and low diversity, three phyla, five classes, 11 orders and 28 families were identified in the study area during the four seasons of the year. The Arthropoda phylum was the most representative in abundance and richness. Regarding to richness, Trichoptera (7 families) and Diptera (6 families) followed by Ephemeroptera (3 families) were the orders that showed the greatest diversity of families, however, a low diversity with a H'≤ 1.5 nit was registered in the study area. We demonstrated through the null models, the randomization in the species associations corresponding to the three analyzed sites. The information provided here contributes to the understanding of the ecological patterns of the invertebrate communities in the Allipén River, establishing the basis for more complex ecological studies.

Um dos indicadores biológicos mais utilizados para determinar a saúde de um ecossistema fluvial são os macroinvertebrados bentônicos. A presença de espécies recorrentes em um amplo gradiente de latitudes domina o padrão biogeográfico dos macroinvertebrados bentônicos nas águas doces do Chile; no entanto, o conhecimento sobre a ecologia comunitária destes nos rios chilenos continua escasso. Os modelos nulos se tornaram uma poderosa ferramenta estatística para descrever os mecanismos ecológicos que orientam a estrutura de uma comunidade ecológica e os padrões subjacentes da diversidade. O objetivo deste estudo foi determinar a estrutura da comunidade de invertebrados bentônicos no rio Allipén, descrevendo sua composição, riqueza e abundância de espécies através de modelos de riqueza e modelos nulos baseados na presença / ausência. Os resultados revelam alta riqueza de espécies e baixa diversidade, sendo identificados três filos, cinco classes, 11 ordens e 28 famílias na área de estudo durante as quatro estações do ano. O filo de Arthropoda foi o mais representativo em abundância e riqueza. Em relação à riqueza, Trichoptera (7) e Diptera (6) seguidos por Ephemeroptera (3) foram as ordens que mostraram a maior diversidade de famílias, no entanto, uma baixa diversidade com H'≤ 1,5 nit foi registrada na área de estudo. Demonstramos através dos modelos nulos, a randomização nas associações de espécies correspondentes aos três locais analisados. As informações aqui fornecidas contribuem para a compreensão dos padrões ecológicos das comunidades de invertebrados no rio Allipén, estabelecendo a base para estudos ecológicos mais complexos.

Community structure of benthic invertebrates in the Allipén River basin, North Patagonia, Araucania region (38º S, Chile) / Estrutura da comunidade de invertebrados bentônicos na bacia do rio Allipén, Patagônia Norte, Região da Araucanía (38º S, Chile)

One of the biological indicators most used to determine the health of a fluvial ecosystem are the benthic macroinvertebrates. The presence of recurrent species in a wide gradient of latitudes, dominates the biogeographic pattern of the benthic macroinvertebrates in Chilean fresh waters, nevertheless the knowledge on the communitarian ecology of these in the Chilean rivers continues to be scarce. Null models became a powerful statistical tool for describing the ecological mechanisms that drive the structure of an ecological community and the underlying patterns of diversity. The objective of this study was to determine the community structure of benthic invertebrates in the Allipén River by describing their composition, richness and abundance of species through richness models and null models based on presence/absence. The results reveal a high family richness and low diversity, three phyla, five classes, 11 orders and 28 families were identified in the study area during the four seasons of the year. The Arthropoda phylum was the most representative in abundance and richness. Regarding to richness, Trichoptera (7 families) and Diptera (6 families) followed by Ephemeroptera (3 families) were the orders that showed the greatest diversity of families, however, a low diversity with a H'≤ 1.5 nit was registered in the study area. We demonstrated through the null models, the randomization in the species associations corresponding to the three analyzed sites. The information provided here contributes to the understanding of the ecological patterns of the invertebrate communities in the Allipén River, establishing the basis for more complex ecological studies.

Um dos indicadores biológicos mais utilizados para determinar a saúde de um ecossistema fluvial são os macroinvertebrados bentônicos. A presença de espécies recorrentes em um amplo gradiente de latitudes domina o padrão biogeográfico dos macroinvertebrados bentônicos nas águas doces do Chile; no entanto, o conhecimento sobre a ecologia comunitária destes nos rios chilenos continua escasso. Os modelos nulos se tornaram uma poderosa ferramenta estatística para descrever os mecanismos ecológicos que orientam a estrutura de uma comunidade ecológica e os padrões subjacentes da diversidade. O objetivo deste estudo foi determinar a estrutura da comunidade de invertebrados bentônicos no rio Allipén, descrevendo sua composição, riqueza e abundância de espécies através de modelos de riqueza e modelos nulos baseados na presença / ausência. Os resultados revelam alta riqueza de espécies e baixa diversidade, sendo identificados três filos, cinco classes, 11 ordens e 28 famílias na área de estudo durante as quatro estações do ano. O filo de Arthropoda foi o mais representativo em abundância e riqueza. Em relação à riqueza, Trichoptera (7) e Diptera (6) seguidos por Ephemeroptera (3) foram as ordens que mostraram a maior diversidade de famílias, no entanto, uma baixa diversidade com H'≤ 1,5 nit foi registrada na área de estudo. Demonstramos através dos modelos nulos, a randomização nas associações de espécies correspondentes aos três locais analisados. As informações aqui fornecidas contribuem para a compreensão dos padrões ecológicos das comunidades de invertebrados no rio Allipén, estabelecendo a base para estudos ecológicos mais complexos.

Community structure of benthic invertebrates in the Allipén River basin, North Patagonia, Araucania region (38º S, Chile)

Abstract One of the biological indicators most used to determine the health of a fluvial ecosystem are the benthic macroinvertebrates. The presence of recurrent species in a wide gradient of latitudes, dominates the biogeographic pattern of the benthic macroinvertebrates in Chilean fresh waters, nevertheless the knowledge on the communitarian ecology of these in the Chilean rivers continues to be scarce. Null models became a powerful statistical tool for describing the ecological mechanisms that drive the structure of an ecological community and the underlying patterns of diversity. The objective of this study was to determine the community structure of benthic invertebrates in the Allipén River by describing their composition, richness and abundance of species through richness models and null models based on presence/absence. The results reveal a high family richness and low diversity, three phyla, five classes, 11 orders and 28 families were identified in the study area during the four seasons of the year. The Arthropoda phylum was the most representative in abundance and richness. Regarding to richness, Trichoptera (7 families) and Diptera (6 families) followed by Ephemeroptera (3 families) were the orders that showed the greatest diversity of families, however, a low diversity with a H 1.5 nit was registered in the study area. We demonstrated through the null models, the randomization in the species associations corresponding to the three analyzed sites. The information provided here contributes to the understanding of the ecological patterns of the invertebrate communities in the Allipén River, establishing the basis for more complex ecological studies.

Resumo Um dos indicadores biológicos mais utilizados para determinar a saúde de um ecossistema fluvial são os macroinvertebrados bentônicos. A presença de espécies recorrentes em um amplo gradiente de latitudes domina o padrão biogeográfico dos macroinvertebrados bentônicos nas águas doces do Chile; no entanto, o conhecimento sobre a ecologia comunitária destes nos rios chilenos continua escasso. Os modelos nulos se tornaram uma poderosa ferramenta estatística para descrever os mecanismos ecológicos que orientam a estrutura de uma comunidade ecológica e os padrões subjacentes da diversidade. O objetivo deste estudo foi determinar a estrutura da comunidade de invertebrados bentônicos no rio Allipén, descrevendo sua composição, riqueza e abundância de espécies através de modelos de riqueza e modelos nulos baseados na presença / ausência. Os resultados revelam alta riqueza de espécies e baixa diversidade, sendo identificados três filos, cinco classes, 11 ordens e 28 famílias na área de estudo durante as quatro estações do ano. O filo de Arthropoda foi o mais representativo em abundância e riqueza. Em relação à riqueza, Trichoptera (7) e Diptera (6) seguidos por Ephemeroptera (3) foram as ordens que mostraram a maior diversidade de famílias, no entanto, uma baixa diversidade com H 1,5 nit foi registrada na área de estudo. Demonstramos através dos modelos nulos, a randomização nas associações de espécies correspondentes aos três locais analisados. As informações aqui fornecidas contribuem para a compreensão dos padrões ecológicos das comunidades de invertebrados no rio Allipén, estabelecendo a base para estudos ecológicos mais complexos.

Community structure of benthic invertebrates in the Allipén River basin, North Patagonia, Araucania region (38º S, Chile).

One of the biological indicators most used to determine the health of a fluvial ecosystem are the benthic macroinvertebrates. The presence of recurrent species in a wide gradient of latitudes, dominates the biogeographic pattern of the benthic macroinvertebrates in Chilean fresh waters, nevertheless the knowledge on the communitarian ecology of these in the Chilean rivers continues to be scarce. Null models became a powerful statistical tool for describing the ecological mechanisms that drive the structure of an ecological community and the underlying patterns of diversity. The objective of this study was to determine the community structure of benthic invertebrates in the Allipén River by describing their composition, richness and abundance of species through richness models and null models based on presence/absence. The results reveal a high family richness and low diversity, three phyla, five classes, 11 orders and 28 families were identified in the study area during the four seasons of the year. The Arthropoda phylum was the most representative in abundance and richness. Regarding to richness, Trichoptera (7 families) and Diptera (6 families) followed by Ephemeroptera (3 families) were the orders that showed the greatest diversity of families, however, a low diversity with a H'≤ 1.5 nit was registered in the study area. We demonstrated through the null models, the randomization in the species associations corresponding to the three analyzed sites. The information provided here contributes to the understanding of the ecological patterns of the invertebrate communities in the Allipén River, establishing the basis for more complex ecological studies.

Función ejecutiva y cociente intelectual en pacientes con diagnóstico de esquizofrenia / Executive function and intellectual quotient in schizophrenic patients / Função executiva e quociente intelectual nos pacientes com diagnóstico de esquizofrenia

La esquizofrenia ha generado el interés de muchos profesionales de la salud, considerada desde un principio como un síndrome clínico que afecta diferentes procesos como el pensamiento, la emoción, los movimientos, el comportamiento, y aspectos cognitivos como la atención, la memoria, el lenguaje y especialmente las funciones ejecutivas. El objetivo del presente estudio fue evaluar las funciones ejecutivas en pacientes con diagnóstico de esquizofrenia para verificar si existe alguna relación con el Cociente Intelectual. Se tomaron 30 pacientes con un mínimo de escolaridad de tres años, que se encontraban recibiendo tratamiento farmacológico y sin evidencia de un retardo mental previo; se les aplicó el Wisconsin Card Sorting Test (WCST) para evaluar las habilidades implicadas en la función ejecutiva y la escala de Inteligencia de Weschler para adultos (WAIS) para determinar el Cociente Intelectual, CI verbal, manipulativo y global. En la población estudiada, se encontró que los pacientes presentaron un deterioro global en cada una de las habilidades implicadas en la función ejecutiva, y se ubicaron en un rango de deficiencia mental en la escala de inteligencia, confirmándose que aunque existe deterioro de las funciones ejecutivas y un nivel de cociente intelectual bajo en los pacientes, no existe correlación entre estas dos variables.

Schizophrenia, considered from the beginning as a clinical syndrome that affects different processes such as thinking, emotions, movements, and behaviour, as well as cognitive aspects such as attention, memory, language and especially the executive functions, is an entity that has arisen the interest of many health professionals. The objective of the present study was to assess the above mentioned functions in patients who had been diagnosed with schizophrenia and later verify if there was a relation with their intellectual quotient. The sample for this research was composed of 30 patients with no evidence of previous mental retardation, who had studied for at least three years and who were receiving the suitable pharmacological treatment. The Wisconsin Card Sorting Test (WCST) was administered to assess the abilities involved in the executive function, and the Weschler Adult Intelligence Scale (WAIS), to determine the verbal, manipulative and global intellectual quotient (IQ). The research results showed that the patients presented a global deterioration in each one of the abilities involved in the executive function and were located within the rank of mental deficiency in the intelligence scale, thus confirming that although patients showed deterioration of the executive functions and a low level of intellectual quotient, there is no correlation between these two variables.

A esquizofrenia tem despertado o interesse de muitos profissionais da saúde. É considerada uma síndrome clínica que afeta diversos processos, como o pensamento, a emoção, os movimentos, o comportamento; e processos cognitivos como a atenção, a memória, a linguagem e, especialmente, as funções executivas. O objetivo deste estudo foi avaliar as funções executivas nos pacientes com diagnóstico de esquizofrenia, para comprovar si há relação com o quociente intelectual. Intervieram 30 pacientes com escolaridade mínima de três anos, que estavam recebendo tratamento farmacológico, e no tinham evidência de atraso mental prévio. Aplicou-se o Wisconsin Card Sorting Tets (WCST) para avaliar as habilidades envolvidas na função executiva e a Escala de Inteligência de Weschler para adultos (WAIS) para determinar o quociente intelectual, o QI verbal, manipulador e global. Foi achado os pacientes apresentarem um deterioro global em cada uma das habilidades envolvidas na função executiva e situarem em um rango de deficiência mental na escala da inteligência. Isto confirma que mesmo se há deterioro das funções executivas e um nível baixo de quociente intelectual nos pacientes, não existe correlação entre estas duas variáveis.

Cambios cognoscitivos en la enfermedad mental de pacientes que asisten al Programa de Hospital Día del Hospital Psiquiátrico Universitario del Valle / Cognitive changes in mentally ill patients who attend the Day Hospital Program of the Hospital Psiquiátrico Universitario del Valle

Las investigaciones han demostrado que la enfermedad mental es causa de disfunciones cognoscitivas, manifestadas en desorden de las ideas y de los sentimientos con trastornos graves del razonamiento, del comportamiento, de la facultad de reconocer la realidad y de adaptarse a los retos normales de la vida. El objetivo de este estudio fue describir, mediante la evaluación neuropsicológica, los cambios cognoscitivos en un grupo de pacientes con enfermedad mental que asistían a un programa de Hospital Día, espacio terapéutico diseñado para la rehabilitación, el cuidado y el acompañamiento del paciente. Se tomaron al azar 25 pacientes entre los 16 y 61 años de edad con una escolaridad mínima de cinco años, y se realizó una valoración neuropsicológica al ingreso (pre) y cinco meses después de dar inicio al tratamiento (pos) con la Evaluación Neuropsicológica Breve en Español, Neuropsi (Ostrosky, Ardila y Roselli, 1994). Los resultados en la preevaluación mostraron que los pacientes con enfermedad mental presentan cambios cognoscitivos en atención, memoria inmediata, evocación con clave semántica, evocación por reconocimiento, memoria visual, comprensión verbal, fluidez verbal semántica, habilidad visoconstruccional, función ejecutiva conceptual y motora; sin embargo, estas funciones cognoscitivas mejoran cuando se asiste regularmente al programa de Hospital Día. Estos resultados hacen evidente la importancia del trabajo terapéutico interdisciplinario, sumado a la farmacoterapia, con el fin de obtener cambios cognoscitivos más estables.

Research has shown that mental illness is caused by cognitive dysfunctions expressed in disorder of ideas and feelings with profound alterations for reasoning, behavioural disorders, and difficulties to recognize reality and adapt to the normal life challenges. The goal of this study was to describe by neuropsychological evaluation the cognitive changes in a group of patients with mental illness who attended a Day Hospital program, a therapeutic space designed for the rehabilitation, care and support of the patients: 25 patients between 16 and 61 years old with a minimum escolarity of five years were randomly selected. A neuropsychological evaluation was conducted before the treatment (pre-evaluation) and five months after the beginning of treatment (post-evaluation). The Brief Neuropsychological Evaluation in Spanish-Neuropsi (Ostrosky, Ardila and Roselli, 1994) was applied. The pre-evaluation results showed that the patients with mental illness present cognitive changes in attention, immediate memory, semantic key evocation, evocation by recognition, visual memory, verbal understanding and semantic verbal fluidity, visoconstructional skills, conceptual, and motor executive functions; however, these cognitive functions improve when patients regularly attend to the Day Hospital program. These results highlight the importance of the interdisciplinary therapeutic work, in addition to pharmacotherapy, in order to achieve more stable cognitive changes.

Factores prequirúrgicos predictores de extensión extracapsular y márgenes positivas en pacientes con adenocarcinoma de próstata, tratados mediante prostatectomía radical en el Hospital San José Bogotá Colombia / Presurgical factors predictors of extracapsular extension and positivo margins in patients with adenocarcinoma of prostate treated with radical prostatectomy in the San José Hospital

Objetivos: 1. Determinar los factores prequirúrgicos predictores de extensión extra capsular, en pacientes con adenocarcinoma de próstata/ tratados mediante prostatectomía radical en el Hospital San José.2. Establecer si existe una correlación entre el Gleason de la biopsia y el Gleason del espécimen definitivo.3. Determinar los factores prequirúrgicos predictores de márgenes quirúrgicas positivas, en pacientes con adenocarcinoma de próstata, tratados mediante prostatectomía radical en el Hospital de San José. Materiales y Métodos: Se revisaron un total de 136 prostatectomías radicales realizadas en el servicio de urología del Hospital de San José entre 1992 y el 2000. Se estudiaron la edad del paciente, el Gleason de la biopsia, el PSA prequirúrgico y el TNM clínico como factores prequirúrgicos para establecer la presencia de extensión extra capsular y márgenes quirúrgicas positivas en el espécimen definitivo de la prostatectomía radical. Los resultados fueron analizados con el programa estadístico Stata statistical software 7.0, Stata Corp.College Station, Texas. USA. Y el software SPSS de correlación y análisis de intergrupos de Duncan. Resultados: El porcentaje de extensión extra capsular según los factores prequirúrgicos fue: 1. Edad: menores de 50 (20 por ciento ); 50 a 60 (52 por ciento ); 60 a 70 (49 por ciento ) y mayores de 70 (53 por ciento ) 2. PSA: menor de 2,5 (42 por ciento ); 2,5 a 4 (50 por ciento ); 4 a 10 (40 por ciento ) 10 a 20 (52 por ciento ) y mayor de 20(66 por ciento ). 3. Gleason de la biopsia: 2 a 4 (38 por ciento ); 4 a 6 (53 por ciento ); 7 (60 por ciento ) y 8 a 10 (62 por ciento ).4. TNM Clínico: T1 (22 por ciento ) T2 (50 por ciento ) y T3 (100 por ciento ). Una vez realizado el análisis multivariable y univariable se pudo establecer que sólo el T3 clínico tiene valor estadístico para establecer extensión extra capsular. Se realizó el mismo análisis para la presencia de márgenes quirúrgicas positivas y se estableció que sólo el T3 clínico y en menor proporción el PSA mayor de 10, predicen la presencia de márgenes quirúrgicas positivas...

Verapamilo intralesional en el manejo de la enfermedad de Peyronie / Intralesional verapamil injection for treatment of disease of Peyronie

Confirmar la efectividad del Verapamilo inyectado intralesionalmente como alternativa de manejo para la Enfermedad de Peyronie y determinar la seguridad de la aplicación de lOmg de verapamilo intraplaca. Diseño: se trata de un estudio de control de casos. Población y lugar: El estudio se realizó en 19 pacientes valorados en la consulta de Urología de los Hospitales San José, San Rafael y Militar Central de Santafé de Bogotá, en un lapso comprendido entre Marzo de 1996 y Enero de 1997. Medición y resultados: se realizaron mediciones objetivas del tamaño de la placa, presencia de calcificaciones, grado de curvatura peneana y se evaluaron los síntomas antes y después de la aplicación semanal de 10 mg de verapamilo intralesional durante mínimo seis meses. Se observó que el verapamilo disminuye el volumen y la consistencia de las placas no calcificadas en un 60 por ciento disminuye la curvatura peneana en un 20 por ciento y elimina el dolor en el 100 por ciento de los pacientes. La mejoría obtenida permitió la reanudación de la actividad sexual satisfactoria en 70 por ciento de los pacientes. No se presentaron efectos colaterales por el uso del verapamilo durante el estudio. Conclusiones: El verapamilo es una terapia efectiva y segura para el tratamiento de los síntomas asociados a la Enfermedad de Peyronie

Experiencia de la prostatectomia radical en pacientes con cancer localizado de prostata en el Hospital de San Jose de Bogotá / Experience in radical prostatectomy with cancer of prostate patients in San Jose Hospital, Bogotá

Objetivos: Presentar los resultados de la prostatectomía radical como tratamiento del cáncer localizado de próstata en la serie estudiada. Compararlos con las series publicadas. Determinar los valores predictivos del PSA y Gleason preoperatorios relacionados con la patología definitiva. Establecer complicaciones perioperatorias, morbi-mortalidad, recidiva tumoral, incontinencia e impotencia asociados a la cirugía. Diseño: Estudio descriptivo de casos con información de historias clínicas, seguimiento y entrevistas con pacientes. Población y lugar: 88 pacientes con diagnóstico de cáncer de próstata localizado, intervenidos entre septiembre/1992 y abril/1997. Intervención: prostatectomía radical con técnica modificada de Waish, previa linfadenectomía ilio-obturadora bilateral examinada por congelación. Medición y resultados: Se utilizaron medidas de tendencia central y de dispersión, mediante EpiInfo 6.04b. La patología definitiva fue organoconfinado 58,8 por ciento, extracapsular 13,8 por ciento, márgenes positivas 15 por ciento y otros 12,5 por ciento. Grado de diferenciación: bien 20.5 por ciento, moderado 39,7 por ciento y mal 39,77o. Tiempo quirúrgico promedio: 3,7 horas, complicaciones perioperatorias: 5,8 por ciento, sin mortalidad. La continencia: 95 por ciento, potencia: 23,4 por ciento POP. El 34,5 por ciento de los pacientes requirieron dilataciones uretrales, con promedio de 2,5/paciente. Recurrencia serológica: 31,87o, recidiva local comprobada: 4,17o y 2 pacientes tienen gamagrafías óseas positivas. Promedio de seguimiento: 17,3 meses. Conclusiones: Se observó subestadificación del 357o. Es una cirugía segura, con baja morbilidad, sin mortalidad perioperatoria. Los índices de continencia y potencia son similares a los reportados en la literatura. No hay un parámetro objetivo que permita predecir la recurrencia real

Political bias, moral values, and spirituality in the training of psychotherapists.

Today psychotherapists face a challenge quite different from Karl Menninger's early efforts to foster an understanding between the new science of psychiatry and traditional religion. Today the mental health sciences are struggling with the contradictions and conflicts about society's values and spirituality that are currently vexing us all. The challenge today for psychotherapists is how to address values and spirituality professionally, ethically, and usefully in our work. This article looks at the scope of the task of training psychotherapists to work with values and spirituality in today's climate of amorphous values and culture wars.

Home/community-based services: a two-tier approach.

A two-tier model for work with high-risk families is presented. It combines multiple-family groups in the community with home-based family therapy for individual families. The ecostructural conceptual framework of the model is discussed, and its application is illustrated by a case vignette.

"If I don't get simple, I cry".

Poor families have taught us special lessons that are applicable to all families. They have instructed us about the problems, within families, of developing relationships adequate to the tasks of family life. One consequence is that therapists are attending more to the evolution of the structure of family relationships, particularly, the phenomenon of underorganization. Poor families have also provided insight into the dynamic relationship between families and their social context. As a result, a therapeutic perspective is emerging that focuses on the influence of the community on the individual and the family, a perspective that may be called an eco-structural approach to therapy.

The negotiation of values in therapy.

Values are integral to all social systemic operations and therefore to the heart of the therapeutic process. For the therapist, values are an essential component in defining and assessing a problem, determining goals, and selecting therapeutic strategy. Therapists do not have a choice about whether they need to deal with values in therapy, only about how well. The training of therapists about their values needs to be integrated with the training about their own emotional and family issues. This training should be carried out in the context of treating families and have as its primary focus the relationship of the therapists' personal issues to the conduct of their therapy with families. Personal insight and mastery over handling their own values and family issues will maximize therapeutic effectiveness.

The Puerto Rican and Cuban public health systems: a comparison.

This article compares the Puerto Rican and Cuban public health and mental health systems and the respective health profiles, emphasizing the role of psychosocial stressors. The Cuban health system was found to be better organized and more capable of providing equitable health care and encouraging community participation in health care delivery. However, the Puerto Rican public health system is in crisis and in the process of turning over the administration of its facilities to the private medical sector. Although both countries share health profiles similar to those of developed nations, differences in morbidity and mortality patterns, and the seemingly epidemic incidence of mental disorders in Puerto Rico suggest dissimilarities between their respective psychosocial stressors. Differences in the quality of public health care and in the health profiles seem mostly attributable to the divergent political and economic organization and priorities of both countries.

Schistosomiasis control in Puerto Rico: twenty-five years of operational experience.

A program to control schistosomiasis in Puerto Rico was initiated in 1953, using limited chemotherapy and snail control by environmental, biological and chemical means. At the same time, extensive programs of water supply, health education, and free latrine distribution were underway throughout the island. The impact of the program was evaluated initially by examinations of fecal samples from first-grade children until 1966, and subsequently by island-wide surveys using adult worm antigen for skin test on fifth-graders in 1963, 1969, and 1976. There was a decrease in the proportion of children reacting positively to the skin test from 24% in 1963 to 5% in 1976. The decrease in the proportion of positive skin test reactions was one and a half times as great in the area under snail control as in the rest of the endemic area, and most of the decrease outside the snail control program was due to improved water supply. Calibration tests indicated a decrease in prevalence among the entire population, if determined by multiple fecal exams, from 15% in 1963 to less than 4% in 1976. Thus the estimated number of persons passing eggs in Puerto Rico was about 100,000 in 1976, in a population of 3 million. The cost of snail control was minimized by emphasizing environmental and biological methods, showing that the disease can be controlled on a large scale with simple techniques. Eradication of the parasite from Puerto Rico is quite likely in the next few years with the advent of the new drug, oxamniquine, and would be a cheaper strategy than continued snail control.